Mission Villa East

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ramin Hashemi conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Caregiver Maria Pacleb. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, ages 60 and over. The facility has an approved hospice waiver for three (3), and bedridden waiver for one (1). During today’s inspection there were six (6) residents in care. LPA and Caregiver Maria Pacleb toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Caregiver Maria Pacleb, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and clients, and reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Caregiver Maria Pacleb to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Oct 29, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Juliana Barfield, David Roman, and Licensing Program Manager (LPM Lizzette Tellez, conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPAs and LPM were welcomed by, identified themselves to, and discussed the purpose of the visit with, Caregiver Alfredo Pacleb. According to the facility’s license, the facility has a maximum capacity of six (6) residents, all of whom may be non-ambulatory. During today’s inspection, there were a total of six (6) residents in care, and per medical records, all were non-ambulatory. This facility does not feature a secured perimeter or delayed egress doors. LPAs accompanied by Alfredo Pacleb, toured the interior and exterior of the facility, and inspected each room. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Hot water temperature in resident bathroom was compliant. There were at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters observed. No pools or bodies of water were observed on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. Deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with Amsal Engdaw, to whom a copy of this report, the LIC 809-D, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Oct 30, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Licensee did not administer medication as prescribed Licensee did not assist resident(s) with incontinence care

Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced visit to the facility. LPA was met at the entrance by Caregiver, Maria Pacleb and Administrator, Amsal Engdaw. After introducing and identifying himself, LPA was allowed in the facility. LPA discussed with Ms. Engdaw, the purpose of the visit which was to initiate a complaint investigation. Upon conclusion of the visit, LPA delivered findings to Caregiver, Maria Pacleb. There were two (2) staff, and six (6) residents present on the day of LPA’s visit. During the visit, LPA conducted a health and safety check and did not observe any health and safety concerns. On May 3, 2024, Community Care Licensing Division (CCLD) received this complaint. The nature of the allegations is the Licensee did not administer medication as prescribed and did not ensure staff assists residents with incontinence care. The Department’s investigation consisted of facility inspection, review of facility and resident records and Unsubstantiated interviews with pertinent residents, staff, and outside sources. The facility serves elderly residents, most of whom, are non-ambulatory and receiving hospice care. LPA reviewed the resident facility and hospice care documents and found no evidence to support facility staff do not provide medications as prescribed or assist residents with incontinence care. Per interviews with staff and residents, staff rotates residents twice an hour and changes undergarments as needed. Two residents were being treated for Stage 2 pressure injuries. Interviews and records indicate the injuries are healing and residents are receiving wound care. None of the residents expressed concerns with any of their care. Staff interviews did not give LPA any indication that they were not carrying out care and supervision. LPA observed the facility to be neat, organized and clean. Residents were wearing clean clothing and bedding appeared clean without offensive odors. LPA observed resident medications and records. Medications were packaged and organized by resident and revealed no indication that they had not been administered as prescribed. Outside source interviews were complimentary of the facility and care being provided and offered no information to substantiate the allegations. The Department has investigated the aforementioned allegations. Based on interviews, LPA observation and review of facility and hospice records, LPA found insufficient evidence to prove the allegations occurred as reported. The preponderance of evidence standard was not met; therefore, the allegations are Unsubstantiated. An exit interview was conducted with Ms. Pacleb, to whom a copy of this report and Licensee/Appeals Rights (LIC 9058 01/16) were provided.the state’s words, verbatim · CDSS document, May 10, 2024 · control 08-AS-20240503160031